Early Studies of Existing Therapy Show Promise in Treating Nerve Injury Linked to Prostate Removal

Early Studies of Existing Therapy Show Promise in Treating Nerve Injury Linked to Prostate Removal

A drug that has been approved for the treatment of chronic nerve disease such as multiple sclerosis called 4-aminopyridine (4AP) may also be used to repair nerve injury from, for example, prostate surgery, according to a new study.

The study, “4‐Aminopyridine Promotes Functional Recovery And Remyelination In Acute Peripheral Nerve Injury,” was published in the journal EMBO Molecular Medicine.

The procedure for prostate removal is sometimes associated with nerve damage, which may cause incontinence and erectile dysfunction, thereby increasing the refusal of patients of prostate cancer to accept the surgery.

Current treatment of traumatic nerve injury consists of following the patients to see whether the affected nerve can spontaneously recover or if surgery is needed to repair the damage.

However, “the patient who may recover is recovering so slowly that nerve-dependent tissues are in jeopardy, and the patient who needs surgery has to wait for weeks for the diagnosis that surgery is appropriate,” John Elfar, one of the senior authors of the study, said in a news release. “That delay means that surgery is less effective.”

But his team found evidence that 4AP may be a potential way to help the body accelerate the repair of nerve injuries. When traumatic nerve injury occurs, the myelin sheath — the material that surrounds and protects nerve fibers — is affected, and so is the activity of the nerve cells. In mice, daily treatment with 4AP promoted the repair of the myelin sheath, thereby improving nerve cell function.

Researchers also found that mice treated with a single dose of 4AP just one day after traumatic nerve damage (with nerves not completely severed) showed improved muscle function within an hour. This result suggests that 4AP may be used to rapidly diagnose whether a patient has nerve injury treatable with this drug or whether surgery will be necessary.

“This is an ideal outcome for development of a treatment to promote tissue regeneration,” said Mark Noble, the other senior author of the study. “The drug we use to identify injuries that need repair of their insulating myelin is the same drug we use to promote the needed repair. As 4AP has been well-studied in chronic injuries, and is approved for treating multiple sclerosis, the new benefits we discovered can be explored rapidly and much more cheaply than is needed for developing an entirely new drug.”

The U.S. Food and Drug Administration (FDA) has already approved a proposed trial for 4AP in patients who exhibit nerve damage following surgery, and researchers and clinicians are now completing the trial plan before they start to recruit patients.

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